Integrating the Healthcare Enterprise The Basics of IHE: Concepts and Process Associate Professor of Radiology Chief, Imaging Informatics Northwestern.

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

The Basics of IHE: Concepts and Process

Associate Professor of Radiology

Chief, Imaging Informatics

Northwestern University

Feinberg School of Medicine

Department of Radiology

David Channin, MD

RSNA Electronic Communications Committee

IHE Strategic Development Committee

IHE Radiology Planning and Technical Committees

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Why Are Standards Important?Why Are Standards Important?

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Why Are Healthcare IT Why Are Healthcare IT Standards Important?Standards Important?

Step #2 toward Crossing the Quality Chasm: “. . . making effective use of information technologies to automate clinical information and make it readily accessible to patients and all members of the care team. An improved information infrastructure is needed to establish effective and timely communication among clinicians and between patients and clinicians.”

- IOM Report, 2001

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What IT Standards EnableWhat IT Standards Enable

Greater efficiency and cost savings

The ability to make best of breed purchasing decisions

Better and more timely communication of medical information

Improved patient safety

Data for outcomes analysis and decision support

The potential to build a system of evidence-based medicine

The potential to develop a truly comprehensive and portable EHR

So why haven’t standards solved all of

healthcare’s interoperability issues?

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ER

The Standards ArchipelagoThe Standards Archipelago

ADT/HIS

CIS

EKG

Cath Lab

Lab

OR

RIS

PACS

Mods Pharm

Islands of data across the healthcare

enterprise

HL7 2.4

DICOM POC DevicesIEEE – POCT

HL7 2.1

NCPDP

Billing

X12/ICD9DICOM

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NAHIT Standards DirectoryNAHIT Standards Directory

“ . . . Since launching a beta version for members only in April, the Alliance has expanded the directory to include 850 voluntary and mandatory standards and electronic links to more than 200 standards development organizations.” The great thing about standards is that there are so many to choose from

-Old Wisecrack

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Standards Alone Are Not EnoughStandards Alone Are Not EnoughToo many standards No clear domain boundaries No clear mapping of information flow across

boundaries Too much generality and ambiguity Version incompatibilities Vendor proprietary interests Complexity!!

We need standards for how to

implement standards!

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Connecting Standards to CareConnecting Standards to Care

Care providers must work with industry to coordinate the implementation of standards to meet their needs Care providers need to identify the key

interoperability problems they face Drive industry to develop and make available

standards-based solutions Implementers need to follow common guidelines in

purchasing and integrating systems that deliver these solutions

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ACR-NEMA Becomes DICOM: ACR-NEMA Becomes DICOM: c. 1992c. 1992

Demonstrations drive awareness and

demand for standards-based solutions

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IHE Grows from DICOM ExperienceIHE Grows from DICOM Experience

Integrating the Healthcare Enterprise: an initiative by healthcare professionals and

industry to improve the way computer systems in healthcare share information

promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs

leads to systems that communicate better, are easier to implement, and enable care providers to use information more effectively

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IHE ProcessIHE ProcessUsers identify desired functionalities that require coordination and communication among multiple systems

E.g., departmental workflow, single sign-on, cross-departmental sharing of documents and information

Find and document standards-based transactions among systems to achieve desired functionality

Apply necessary constraints to eliminate useless wiggle room

Provide process and tools to encourage vendors to implement

MESA software test tools Connectathon interoperability testing event

Provide tools and education to help users acquire and integrate systems using these solutions

Connectathon results and public demonstrations Integration statements RFP toolkit (soon)

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IHE ParticipantsIHE ParticipantsSocieties Representing Healthcare Segments RSNA, HIMSS, ACC, ACCE, …

Users Clinicians, Medical Staff, Administrators, CIOs, …

Consultants

Information Systems Vendors

Imaging Systems Vendors

Standards Development Organizations (SDOs) DICOM, HL7, ASTM, …

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IHE DeliverablesIHE Deliverables

Technical Framework

Integration Profiles

Connectathon

Public Demonstrations

Tools for Acquiring Conformant Products

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IHE Technical FrameworksIHE Technical Frameworks

Detailed standards implementation guides

–Cardiology

–IT Infra

–Lab

–Radiology

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Organization of TFsOrganization of TFs

Volume 1: Integration Profiles Describes clinical need and use cases Identifies the actors and transactions

Volume 2+ of Technical Framework Provides implementation specification for each

transaction

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Organization of TFsOrganization of TFs

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IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Present-ation of Images

Basic Security

-

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Portable Data for Imaging

NMImage

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imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

ADT (Registration)

Order Placer

Order Filler

Print Server

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

ImageDisplay

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

Example: IHE Scheduled WorkflowExample: IHE Scheduled Workflow

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IHE IT Infrastructure Integration ProfilesIHE IT Infrastructure Integration Profiles

Enterprise User Authentication

Provide users a single nameand

centralized authentication process

across all systems

Enterprise User Authentication

Provide users a single name and

centralized authentication process

across all systems

Retrieve Information for Display

Access a patient’s clinical information and documents in a format ready to be

presentedto the requesting

user

Retrieve Information for Display

Access a patient’s clinical information

and documents in a format ready to be presented to the

requesting user

Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains

Patient Identifier Cross-referencing

for MPI

Map patient identifiers across independent

identification domains

Synchronize multiple applications on a

desktop to the same patient

Patient Synchronized Applications

Synchronize multiple applications on a

desktop to the same patient

Patient Synchronized Applications

Consistent Time

Coordinate time across networked systems

Consistent Time

Coordinate time across networked systems

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IHE ConnectathonIHE Connectathon

Open invitation to vendor community

Advance testing tools (MESA)

Testing organized and supervised by project management team

Thousands of cross-vendor tests performed

Results recorded and published

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RFPs & IHE Integration StatementsRFPs & IHE Integration Statements

Be Brief? “The system must support DICOM”

Be Effective? “The system must support the following DICOM services

according to the following 100 pages of specifications”

Be Both: “The system must support IHE Scheduled Workflow as an

Acquisition Modality”

IHE Integration Statements Version 2.1 of the Jupiter 3 CT supports IHE Scheduled

Workflow as an Acquisition Modality

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Integration StatementsIntegration Statements

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RFP ToolkitRFP Toolkit

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RFP ToolkitRFP Toolkit

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IHE Radiology ActivitiesIHE Radiology ActivitiesNew Supplements Media Distribution Profile NM Image Profile

Departmental Workflow White Paper Report Export Extension

Instance Availability Notification Transaction Appointment Notification Transaction

www.rsna.org/ihe/ (Follow Link for Supp. & Forum)

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IHE IT Infrastructure ActivitiesIHE IT Infrastructure Activities

Finalizing Profile Candidates EHR (Electronic Healthcare Record) Registries Basic Security “Profile Migration/Template” DICOM Configuration (LDAP) Patient Demographics Query White Pages

www.himss.org/ihe/

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New IHE DomainsNew IHE DomainsIHE Lab Initiated by IHE-Europe & IHE-Japan Lab Workflow Profile Released

for Trial Implementation www.gmsih.fr/ihe

IHE Cardiology Sponsored by ACC, ESC, GMSIH Finalizing Supplement Candidates

• Cath Lab Workflow• Echo Workflow• ECG Report Retrieval for Display

IHE expanding, more info.IHE expanding, more info.

• IHE Radiology www.rsna.org/ihe 12 Integration Profiles availableIHE Connectathon for IT January 2004

• IHE IT Infrastructure www.himss.org/ihe 5 Integration Profiles availableIHE Connectathon for IT January 2004

• IHE Laboratory www.gmsih.fr/ihe Framework in Public Comment, feedback due Nov 15th

IHE Connectathon for Lab March 2004

• IHE CardiologyCommitted sponsorship by ACC, ESC, HIMSS.Kick Off December 2004 – First Demo ACC March 2005

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What can you do?What can you do?

Learn about IHE

Participate in IHE planning

Insist on IHE compliance in your RFPs and contract documents

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More information….More information….IHE Web sites:

http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm.

Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0

Technical Framework Supplements - Trial Implementation• May 2004: Radiology• August 2004: Cardiology, IT Infrastructure

Non-Technical Brochures :• Calls for Participation• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements